Impact of a Computer-Assisted SBIRT Program in an HIV Care Setting This application addresses broad Challenge Area (04) Clinical Research and specific Challenge Topic, 04-DA- 110: Screening, Brief Intervention, and Referral to Treatment. Many studies have demonstrated the relationship between drug/alcohol use in HIV infected patients and morbidity and mortality. Other studies have demonstrated a relationship between drug/alcohol use and high- risk HIV transmission risk behaviors, including unprotected anal and vaginal intercourse with HIV seronegative partners. Even with these documented relationships, however, drug and alcohol use is often not addressed with patients in HIV primary care settings. The screening, brief intervention, and referral to treatment (SBIRT) strategy has been found to be effective in a number of populations, but SBIRT for drug/alcohol use has not been tested in an HIV primary care setting. Therefore, the goal of the proposed project is to assess the impact of SBIRT for harmful alcohol use, illicit drug use, and opioid analgesic use in an HIV primary care setting at San Francisco General Hospital's Positive Health Program (PHP). Specifically, the project aims to examine and compare the feasibility, acceptability and impact of conducting SBIRT through (1) a self-administered, web-based Personal Health Record compared to (2) a provider-administered protocol during clinic appointments. A randomized, two-arm cohort methodology will be used. Three hundred HIV-positive clinic patients will be enrolled, and will receive the SBIRT either through the web-based system (called myHERO), or from a provider with results entered into the electronic medical record system (called HERO). Participants will be seen for four study visits (baseline, 1 Month, 3 Months, 6 Months). SBIRT will be conducted at baseline and at 6 Months. The screening instruments will include the "Alcohol, Smoking and Substance Involvement Screening Test" and "The Alcohol Use Disorders Identification Test." The screening tool scores and interpretation will be added to the Active Problem List in the patient's electronic medical record, and will alert the provider to the need for follow-up. The brief intervention and referral to treatment will be delivered by a clinic- based social worker trained in substance use counseling and motivational interviewing techniques. Participants will be assessed at all four visits for the outcome indicators including alcohol and drug use, HIV transmission risk behaviors, and antiretroviral medication adherence. Enhancing the capacity of the HIV Positive Health Program (PHP) to implement standardized screening for substance use and, when indicated, a systematic approach to brief intervention and referral for more in-depth treatment as needed, has the potential to address preventable health problems among HIV infected clinic patients. More broadly, the project has the potential to reduce morbidity and mortality among HIV-positive people, use technological innovation to improve clinic quality of care, and increase engagement of patients in their own health and healthcare. PUBLIC HEALTH RELEVANCE: Despite research with HIV-positive patients showing relationships between drug/alcohol use and increased morbidity, mortality, and HIV transmission risk behaviors, many HIV primary care providers do not address drug and alcohol use with their patients. The purpose of this study is to test two mechanisms for screening patients for alcohol and drug use, for conducting a brief intervention, and for referring people for specialized care: (1) a web-based personal health record, and (2) a provider-administered protocol during clinic appointments. If these mechanisms are found to be effective, they may reduce morbidity and mortality among HIV-positive patients, and could be adapted for use with other illnesses.